Encyclopedia of

Psychodynamic psychotherapy

Photo by: Lisa F. Young

Definition

Psychodynamic
psychotherapy
is a method of verbal communication used to help a person find relief
from emotional pain. It is based on the theories and techniques of
psychoanalysis
. Psychodynamic psychotherapy is similar to psychoanalysis in that it
attributes emotional problems to the patient's unconscious motives
and conflicts. It differs from classical psychoanalysis, however, in that
psychodynamic psychotherapists do not necessarily accept Freud's
view that these unconscious motives and conflicts are ultimately sexual in
nature.

Purpose

The goals of psychodynamic psychotherapy vary depending on the method of
treatment, which can be broadly described as either expressive or
supportive. Expressive therapy seeks to relieve symptoms through the
development of insight, or the slowly developing awareness of feelings and
thoughts that were once outside of the person's awareness.
Expressive therapy is based on the rationale that difficulties experienced
in adult life originate in childhood; that children do not possess the
maturity for making effective choices nor the independence to do so; and
that methods of adapting that were developed in childhood may no longer be
effective for adapting to the world as an adult. Through guidance from a
therapist, the adult becomes aware of present ways of coping that are
ineffective and how they served a purpose in childhood that is no longer
relevant. The person learns that he or she now has a range of new options
for solving problems, and for living in general that are now based on his
or her maturity and independence.

In contrast to expressive therapy which is exploratory, supportive therapy
remains closer to the surface of the patient's issues. Supportive
therapy is an approach that is used to relieve immediate distress; to
return the person to his or her previous level of functioning; and to
strengthen adaptive ways of coping that the individual already possesses
in order to prevent further discomfort. Expressive and supportive methods
of treatment are not completely separate categories because elements of
supportive therapy are used in expressive treatment and vice versa,
depending on the therapeutic need. For instance, if a person in
exploratory treatment is experiencing distress, a supportive approach may
be used for a period of time in order to help the person feel more stable.

While many patients benefit from individual psychotherapy alone, some
instances call for such additional therapies as
family therapy
,
couples therapy
, or
group therapy
in combination with individual treatment. A second treatment modality
might be recommended when the patient's progress in individual
treatment is highly dependent on relationships with significant others or
with interpersonal relationships in general. Psychotropic (mood- or
behavior-altering) medication may also be prescribed as an adjunct (help)
to treatment in order to manage disturbances in anxiety level, mood or
thinking. Whether additional treatments are recommended is based on the
needs of the individual.

People seek psychodynamic psychotherapy for a variety of reasons that
include but are not limited to the following: prolonged sadness, anxiety,
sexual difficulties, physical symptoms without physical basis, persistent
feelings of isolation and loneliness, and the desire to be more successful
in work or love. People seek therapy because they have not been able to
develop a stable resolution for their difficulties on their own or with
the help of friends and family members.

Description

Sessions of psychodynamic psychotherapy may be scheduled from one to three
days per week, with greater frequency allowing for more in-depth
treatment. The duration of individual sessions varies, but typically lasts
for 45–50 minutes. It is not usually possible at the outset of
treatment to estimate the number of sessions that will be necessary in
order to achieve the person's goals. It is possible, however, for
the person to make arrangements for a specific number of sessions.

Psychodynamic psychotherapy begins with a period of evaluation during
which the client discusses with the
therapist the reasons for seeking treatment. This process gives the
therapist the opportunity to learn about the person, to develop an
understanding of his or her troubles, and to formulate ideas about how
treatment should proceed. This phase of interviewing and learning may take
place in one session or over a series of sessions; or it may be done in a
less structured manner, depending on the therapist's style. During
the initial sessions, such factors as the frequency and length of sessions
and the policy for payment will also be discussed. At some point within
the first few sessions, the therapist and the individual will come to a
mutual understanding of the goals for treatment. After this point, the
sessions will become less like an interview; the person is asked to say
whatever is on his or her mind. It is the therapist's job to listen
and to help identify patterns of thinking, feeling and interacting that
may be contributing to the patient's current struggles.
Consequently, the person becomes more aware of his or her thoughts and
feelings; learns how some present ways of coping are no longer adaptive
even though they may have been necessary in childhood; and discovers that
he or she as an adult has a greatly expanded repertoire of resources and
can use far more effective ways of dealing with problems. Deeper awareness
and new insights stimulate psychological growth and change.

Psychodynamic psychotherapy places great importance on the therapeutic
dyad, which is a medical term for the relationship between the therapist
and the patient. It is within the context of the therapeutic dyad that
positive changes in the patient's outlook and behaviors are able to
unfold. This relationship is unique because the therapist maintains a
uniform, neutral and accepting stance. Unlike other well-intentioned
people in the person's life, the therapist has been trained to
listen objectively and without criticism. This therapeutic attitude makes
it easier for the person seeking treatment to speak freely and to
therefore provide as much information for the therapist to work with as is
possible.

Treatment continues until the troubling symptoms have been reduced or
alleviated and the person is consistently making use of more adaptive
methods of coping with greater insight. For some people, this positive
experience inspires them to proceed with further treatment in order to
bring about additional adaptive changes. For others, meeting the initial
goals will be sufficient. If so, the focus of sessions turns to issues
related to the end of treatment. This final phase of treatment is as
important as the beginning and middle stages because it allows the
individual to develop insight about his or her therapeutic experience.
People need time to clarify how they feel about leaving the therapeutic
relationship, and this termination involves identifying and understanding
feelings about separation, maturation, loss and change. The length of time
allotted to the termination phase varies with the type of treatment and
with the needs of the individual.

Normal results

After a course of psychodynamic psychotherapy has ended, the person
should, overall, continue to handle difficulties in a more adaptive
manner; experience improved interpersonal relationships and productivity
at work; and continue to develop new insights into his or her thoughts,
feelings and behavior. In supportive treatment, insight and personality
change are not the primary goals of treatment; the therapist and patient
work toward a continuation of general stability in the person's
life.